On the edge

June 15, 2003

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"A lot of people have no idea how scary it is to have no health insurance," said Walter Price."When you don't have insurance, you're suddenly right there on the edge. If I have a bad accident or need a major operation, a week in the hospital could wipe out everything I own. Even if I managed to keep my home, I'd be a pauper. A hospital won't hesitate for a New York second to put a lien on everything you own."Price, a former Republican legislator from Charleston, serves on the state Housing Development Fund board. At age 54, he has no insurance. His premiums rose abruptly to $886 a month after he had surgery for a gallbladder condition and kidney stones.He had to drop his policy. "I simply couldn't afford it anymore," he said."I never for a minute thought I'd be in this situation," Price said. "Middle-class people don't think they have a problem, but many are a capricious boss' decision away from the free clinic. This is stuff that could happen to people who live in nice homes in South Hills."One in four working-age West Virginians — nearly 300,000 — had no health insurance for all or part of 2001, according to a WVU survey. More than 60 percent of them are employed."I don't know why people aren't out demonstrating in the streets," Price said. "Don't they know what's happening? Don't they understand what their position is?"Five years from now, if health-care costs don't slow down, 60,000 more West Virginians will have no insurance, Mountain State Blue Cross/Blue Shield predicts. Many simply will no longer be able to afford it.If that happens, the "one in four" will become one in three.By 2008, a family health insurance policy may cost at least $18,000 in West Virginia, said Greg Smith, CEO of Mountain State Blue Cross/Blue Shield. People who buy their own insurance would have to pay every dollar. Employees could expect to pay a large chunk."How many people in West Virginia can possibly afford that kind of premium?" Smith asked. "And what business can afford it?"Not many. The per capita income in West Virginia is $23,688.And Mountain State Blue Cross/Blue Shield's prices are some of the state's lowest."The price of all health insurance will roughly double in the next five years if the cost of health care keeps going up like it has been," said Fred Holliday. "It's straightforward math."Holliday should know. He analyzes insurance rates for the West Virginia Insurance Commission. "This affects everybody," he said.

Last year, national health care spending grew four times faster than the national economy grew. The ripple effects in people's lives are enormous:

"People are making basic life choices because of insurance," said Maureen Conley, Charleston Legal Aid lawyer. "I see people deciding to get married because of health insurance and people deciding to get divorced because of health insurance. Deciding not to have kids, deciding it's too risky to go back to school."

People are postponing retirement to hang on to insurance or because they fear rising co-pays with no paycheck, said David Haney, director of the West Virginia Education Association. State employee insurance costs will double, too.

"In labor negotiations now, the first day you talk about health-care coverage, and the last day you talk about health-care coverage," said Jim Bowen, president of the AFL-CIO Labor Federation. "You don't talk about pensions and vacations anymore. You don't even talk about wages much anymore. You talk about health care, insurance plans."

Why is this happening? So many things contribute to insurance bills, Holliday said. But the rising cost of health care in the United States is the big one.Two of the nation's most prestigious health-care experts laid out the big picture

in the May/June issue of Health Affairs in an article called "It's the Prices, Stupid: Why the United States is So Different from Other Countries" (www.healthaffairs.org).Health care in the United States costs more than twice as much per person as it does in other developed countries, according to the Organization for Economic Cooperation and Development."It's that one thing out there that can destroy us all financially," said WVEA's Haney. "People don't believe there's a national crisis, but it's a monster, and it's going to eat us all alive — you, me, and our grandchildren — if we don't do something about it now."People who administer health-care programs have seen this dragon coming for years."People just don't realize how vulnerable we are in this country," said Renate Pore, director of the Governor's Cabinet on Children and Families. "So many people are one accident, one job loss, one rate hike, or one disease away from being priced out of the market.""Insurance used to be the thing that stood between people and huge health-care bills," said Sharon Carte, Director of the Children's Health Insurance Program. "Now insurance itself is another huge bill. Or it's just unaffordable. And if you don't have it these days, every day you get up and risk financial disaster."'I try not to think about what could happen'
Joan and Vern DeLung of Mossy, Fayette County, know firsthand what these people are talking about. Without health insurance, if one of them has an accident, medical bills could wipe out their savings, their home and the rest of what they own.They insure their 16-year-old son for $256 a month because they make too much to qualify for the Children's Health Insurance Program. They can't afford to insure themselves, too.Vern DeLung, 41, a veteran electrician, has severe joint pain, but can't afford the medicine that would give him relief. "I live on Tylenol and ibuprofen," he said. "Some days, I hurt from my nose to my toes."I try not to think about what could happen. When I think about the future, I think about getting up and going to work."For 20 years, he has helped wire buildings all over Southern West Virginia, including the Tamarack arts and crafts center. Now he drives 260 miles, round trip, to Greenbrier East High School every workday. Some days, he works on his hands and knees for hours or contorts his body to work in cramped areas. "I ache every day," he said. "That's how it is."Like many uninsured people, he doesn't always get the medical care he needs. A few years ago, he got a staph infection on his leg. His doctor told him he might lose his leg if he didn't go in the hospital. "We didn't have the money for that," he said. He kept going to work and checked with the doctor every other day.'Something working people could afford'A sizable chunk of the West Virginia middle class now has no health insurance. Almost half of uninsured working-age West Virginians make at least $20,000 a year. More than a quarter earn at least $30,000. And nearly 10 percent make at least $40,000.The WVU Institute for Health Policy Research assembled those figures for its 2002-03 study, "Health Insurance in West Virginia." Before it was published, nobody really knew how many uninsured people there were in the state.Working-age people have no real safety net. If a couple makes more than $20,000, they aren't eligible for the free clinic. Medicare pays part of the bills for people 65 and older. And the Children's Health Insurance Program is a bright spot in the state's insurance picture."We've done a great job of insuring low-income children through the Children's Insurance Program," said Pore, the governor's cabinet director. Nationally, 13 percent of children are uninsured. Less than 7 percent of West Virginia's children are uninsured, thanks to a strong statewide sign-up effort."This is something West Virginia can be truly proud of," Pore said. "Now if we could just do the same for adults."But the demand for CHIP threatens to swamp it. The Legislative Auditor's Office warns that the program could run $20 million short by 2007."We should take care of the children first," said Joan DeLung. "But it would be great if they could offer something working people could afford to buy."

Five days a week, DeLung provides home care for a 97-year-old woman. She sees firsthand the risks and expense of old age. "I sometimes think 'That's going to be me someday,' and then I put the thought away. I try hard not to think about it."Her only son is starting college this fall. Monthly expenses eat up their paychecks: thousands of miles driving to work, groceries, car insurance, their son's health insurance."With premiums rising higher all the time, it doesn't look like Vern and I will ever get insurance. We've got Joshua to put through college, and by the time he gets through, the premiums will be so high, we'll probably just have to tough it out."'We're the wealthiest country in the world'Like the DeLungs, most uninsured West Virginians work. Many work more than 40 hours a week.Uninsured people are everywhere, said Pat White, West Virginia Health Right administrator."It could be your next-door neighbor who lost her insurance coverage when the employer dropped the insurance," she said. "Or somebody who has a pre-existing medical condition and no insurance plan will take him. Or maybe a friend who lost their job because their employer downsized, and they're on unemployment and can't afford the premium. It could be the older woman who got divorced and can't keep up the insurance."It could be the person who's trying to start a small business and is barely scraping by. The elderly person who needs medication that costs hundreds every month, that Medicare doesn't pay for."The whole subject of health-care costs is maddening," White said. "We're the wealthiest country in the world, but we can't do anything as simple as providing medicine for people who need it. Seems like our priorities are backwards. And the numbers just continue to grow."Many people don't want to talk about it, especially people who have lost their insurance. "I don't want my name in the paper," said a woman whose husband lost his job at Union Carbide after Dow took over. "We're in our 60s, and when you're laid off with no insurance, it's devastating."We wait and hope. West Virginia isn't overflowing with jobs. In the meantime, we're getting by. We live in a mobile home. We don't drink or smoke. I cut my husband's hair. We save pennies where we can.""That's one of the saddest things about this whole insurance situation," said Pore of the governor's cabinet. "A lot of people are ashamed of the fact that they don't have health insurance. They feel that it's a failure on their part. They don't realize that this is happening to so many people."Five years from nowThe Sunday Gazette-Mail asked the Insurance Commission to calculate what West Virginia insurance prices might be in 2008 if health-care costs keep rising at the same rate. The commission found that:

Five years from now, a 45-year-old West Virginia woman with no medical problems would have to pay between $500 and $1,500 a month for a standard policy — no vision, no dental, $500 deductible. Today, she might pay between $250 and $750 a month, depending on the company.

By 2008, a healthy 55-year-old man with no medical problems would have to pay between $710 and $1,800 a month, depending on the company. Today, that man would pay between $355 and $750 a month.

The Insurance Commission's Fred Holliday projected the prices, using figures supplied by the companies. Mountain State Blue Cross is the lower figure. The higher figure is Continental Insurance.A three-month slight slowdown in health-care price inflation doesn't change his projections, he said. "Prices often go down temporarily, then take off again," he said. "We'd need more than three months of data to call it a trend."The Rev. James Patterson, pastor of the Institute Church of the Nazarene, is one of the people teetering on the edge of no insurance. He is diabetic. Every month, his church scrapes together $850 to pay his health insurance. As health costs rise, "it could become out of reach," he said.At the same time, many of his congregation members and neighbors have their own insurance troubles. "I'm seeing people who are getting laid off from Dow Chemical or Verizon, people my age, who have health problems without adequate insurance," he said."Dow Chemical is not going to be able to pay twice what they're paying now for health care," Patterson said. "They can't do that. Nobody can."How high could health bills rise? The state Health Care Authority supplied statewide average prices for hospital bills only. These prices do not include doctor fees, medication, or other fees:

Today, an adult with pneumonia, without complications, can expect, — on average — a $5,535 bill from the hospital. Doubled, five years from now, that bill would be over $11,000.

If you have an appendectomy without complications, you can expect a bill for $8,227 from the hospital. Five years from now, that bill could be in the neighborhood of $17,000.

A new baby? Today, a vaginal delivery without complications produces an average hospital bill of $3,337, for care of the mother only. In 2008, that mother-only hospital bill could be nearly $7,000.

That's just the hospital bill. Those prices do not include doctor bills, lab tests, anesthesia, or whatever else is involved.To cover such costs, insurance companies would hike their rates. More people would drop their insurance. "It's a terrible vicious cycle," said Carte, CHIP director.'Is it right for people not to have access to care?'"It comes back to the fundamental question of right and wrong," Patterson said. "Under biblical principles, is it right for people not to have access to care? We say that we're a God-fearing country, and 'In God We Trust.' If that's true, then certainly there are people who could find it within their power to do something about this."Gov. Bob Wise has ordered his department heads to do something. Early in his administration, he gathered them together and told them he wanted to insure every person in the state. He ordered them to work together."He has been very adamant about that," said Sonia Chambers, Health Care Authority chairwoman. "We don't have time or money to waste."After taking stock of the situation, they decided to try to cut the number of uninsured West Virginians in half within five years.It can't happen soon enough for Cynthia Ray. "Once upon a time, I had insurance, very good insurance," the Fairmont resident said. "So I know the difference between having insurance and not." Ray was a union coal miner before she was laid off in 1995.Now she has cysts on her kidneys, she said. She runs her own business, selling pottery in antique malls. "For a while, it looked like a go. But now, with the rest of the economy down, it's not holding its own as well as I'd hoped."A month ago, I went to my doctor. He still insists that I have an MRI, and I still can't afford it. But we still make sure that I'm alive, that I'm not going to keel over."Last winter, she was furious, she said, to see the Legislature loan state doctors $24 million of the tobacco settlement money to help start the doctors' insurance fund. "I didn't know how many people in West Virginia were like me, uninsured, but I guessed there were lots of them, maybe even hundreds of thousands."Ordinary people need that help, too, she said. "Other industrialized countries have health care for everyone. We need to catch up. When they say the pursuit of life, liberty and happiness, part of life is being able to live. We're all going to die, but we don't need to die from lack of medical care."This month, she got on the Internet and found Pennsylvania has started a new prescription-drug insurance program for people over 64. "And I think, gee, maybe I should move to Pennsylvania. It's 30 minutes away."But the people in West Virginia, not all of us can move to Pennsylvania. We need something here. And a lot of us need it now."Staff writer John Heys contributed to this story. To contact staff writer Kate Long, use e-mail or call 348-1798. Monday in the Charleston Gazette: What is the Wise administation doing to help? For extra charts, details, and links, visit www.wvgazette.com/uninsured.